MEDICARE: DR. TAMETA ROSETTE CLARK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	MD24504	ME

General Provider Information

NPI Number	:	1952571143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAMETA ROSETTE CLARK MD

Provider Business Mailing Address
First Line	:	6307 GATEWAY CIR
Second Line	:
City	:	SCARBOROUGH
State	:	ME
Zip	:	04074-5540
Country	:	US
Telephone Number	:	919-225-7085
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 VIRGINIA AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-3709
Country	:	US
Telephone Number	:	224-278-3000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2008
Last Update Date	:	12/16/2024

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